Wang Wei, Wei Feng, Li RanHao, Tian JiaHui
Department of Endocrinology, First Affiliated Hospital of Baotou Medical Collage, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia, China.
Medicine (Baltimore). 2019 Oct;98(43):e17418. doi: 10.1097/MD.0000000000017418.
Primary aldosteronism (PA) comprises 2 main subtypes: unilateral aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism or named as bilateral adrenal hyperplasia (BAH). An accurate discrimination between APA and BAH is crucial because the former is treated with adrenalectomy (ADX) and the latter is primarily by aldosterone antagonists. We report a case of idiopathic hyperaldosteronism characterized by BAH.
A 46-year-old woman had experienced a paroxysmal elevation of blood pressure for the past 2 months, along with an intermittent headache and mild occipital swelling and pain.
We performed clinical, laboratory, and imaging tests, as well as bilateral adrenal vein sampling (AVS) on this patient. Specifically, computed tomography scan and magnetic resonance imaging were used to characterize the properties of bilateral adrenal adenoma. Additionally, bilateral AVS was performed to distinguish unilateral from bilateral adrenal abnormality in this patient.
After oral administration of aldosterone antagonists, her blood pressure and potassium levels returned to normal ranges and her condition improved.
Following differential diagnosis, screening, functional tests, a variety of imaging studies, and bilateral adrenal vein sampling (AVS) typing, she was finally diagnosed with idiopathic hyperaldosteronism.
For PA patients with lack of typical hypertension and hypokalemia performance, early identification and accurate diagnosis are of great significance for improving the prognosis of BAH. AVS plays an important role in the classification of PA subtype, especially for the cases with bilateral lesions. In regard to patients with rare bilateral adrenocortical adenoma-type aldosteronism, AVS plays a key role in choosing the appropriate treatment regimen.
原发性醛固酮增多症（PA）主要包括2种亚型：单侧醛固酮分泌腺瘤（APA）和特发性醛固酮增多症或称为双侧肾上腺增生（BAH）。准确区分APA和BAH至关重要，因为前者采用肾上腺切除术（ADX）治疗，而后者主要使用醛固酮拮抗剂治疗。我们报告1例以BAH为特征的特发性醛固酮增多症病例。
一名46岁女性在过去2个月里出现血压阵发性升高，伴有间歇性头痛以及枕部轻度肿胀和疼痛。
我们对该患者进行了临床、实验室及影像学检查，以及双侧肾上腺静脉采血（AVS）。具体而言，使用计算机断层扫描和磁共振成像来描述双侧肾上腺腺瘤的特征。此外，进行双侧AVS以区分该患者肾上腺异常是单侧还是双侧。
口服醛固酮拮抗剂后，她的血压和血钾水平恢复至正常范围，病情有所改善。
经过鉴别诊断、筛查、功能测试、多种影像学检查以及双侧肾上腺静脉采血（AVS）分型后，她最终被诊断为特发性醛固酮增多症。
对于缺乏典型高血压和低钾血症表现的PA患者，早期识别和准确诊断对于改善BAH的预后具有重要意义。AVS在PA亚型分类中发挥着重要作用，尤其是对于双侧病变的病例。对于罕见的双侧肾上腺皮质腺瘤型醛固酮增多症患者，AVS在选择合适的治疗方案中起关键作用。
